May 24, 2014

Life Expectancy For Those With Mental Illness Is Lower Than That Of Heavy Smokers

A great deal of research and marketing has gone into understanding exactly how smoking changes your life expectancy. The outcomes from heavy smoking are bleak, and most people are well aware of these facts. Recently, a team of scientists from Oxford University decided to compare the mortality rates of heavy smoking with those of some of the more common mental illnesses, and the results were surprising.

On average, the study found that mental illness reduces a person's life expectancy by 10 to 20 years. This is equivalent, or worse than, the loss of years attributed to heavy smoking. The study, published in World Psychiatry, hopes to galvanize governments and social services to put a much higher priority on dealing with mental health issues as a public health issue, the way they do with smoking.

The researchers say that an estimated 25 percent of people in the UK will experience some sort of mental health issue in the course of a year. The number of smokers is similar, with 21 percent of men and 19 percent of women identified as smokers.

To conduct their analysis, the research team collected 20 of the best systemic reviews of clinical studies reporting on mortality rates for a wide range of diagnoses — mental health problems, substance and alcohol abuse, dementia, autistic spectrum disorders, learning disability and childhood behavioral disorders. In total, these studies included over 1.7 million individuals and over 250,000 deaths.

A second collection of studies and reviews was conducted, this time with those reporting life expectancy and risk of dying by suicide. The results were then compared to mortality risks for heavy smoking.

The researchers found that, on average, heavy smokers lose eight to 10 years.

The reduction in average life expectancy for mental illnesses varies. For example, people with bipolar disorder average between nine and 20 years. Schizophrenia sufferers see a reduction of 10 to 20 years, drug and alcohol abuse garners between nine and 24 years, and sufferers of recurrent depression lose seven to 11 years.

Every diagnosis covered in the studies showed an increase in mortality risk. Even though the risk varied greatly between diagnoses, many of them were equal to or greater than that of heavy smoking.

According to a statement by Dr Seena Fazel of the Department of Psychiatry at Oxford University: “We found that many mental health diagnoses are associated with a drop in life expectancy as great as that associated with smoking 20 or more cigarettes a day.”

“There are likely to be many reasons for this. High-risk behaviors are common in psychiatric patients, especially drug and alcohol abuse, and they are more likely to die by suicide. The stigma surrounding mental health may mean people aren't treated as well for physical health problems when they do see a doctor.”

Fazel, who is also an honorary consultant in forensic psychiatry, believes that one challenge is the tendency of doctors and patients to separate mental illness and physical illness. “Many causes of mental health problems also have physical consequences, and mental illness worsens the prognosis of a range of physical illnesses, especially heart disease, diabetes and cancer. Unfortunately, people with serious mental illnesses may not access healthcare effectively,” says Dr Fazel.

Dr Fazel is certain, however, that “All of this can be changed. There are effective drug and psychological treatments for mental health problems. We can improve mental health and social care provision. That means making sure people have straightforward access to health care and appropriate jobs and meaningful daytime activities. It'll be challenging, but it can be done.”

He notes, “Beyond that, psychiatrists have a particular responsibility as doctors to ensure that the physical health of their patients is not neglected. De-medicalization of psychiatric services mitigates against that.”

Fazel feels that his results should be a wakeup call for governments and clinicians. He adds, “What we do need is for researchers, care providers and governments to make mental health a much higher priority for research and innovation. Smoking is recognized as a huge public health problem. There are effective ways to target smoking, and with political will and funding, rates of smoking-related deaths have started to decline. We now need a similar effort in mental health.”

Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust, which funded the study, said, “People with mental health problems are among the most vulnerable in society. This work emphasizes how crucial it is that they have access to appropriate healthcare and advice, which is not always the case. We now have strong evidence that mental illness is just as threatening to life expectancy as other public health threats such as smoking.”